1.3 Hypertensive Retinopathy

Hypertensive Retinopathy

Signs and Symptoms The patient with hypertensive retinopathy, as expected, suffers from hypertension. However, the hypertension may be unknown to th e patient and the eye exam may yield the first clue to this relative asymptomatic systemic disease. Most commonly, the patient is middle age or older. In addition, hypertension is more common in African-Americans than Caucasians. Patients with only hypertensive retinopathy are nearly always visually asymptomatic.

Findings in hypertensive retinopathy include cotton wool spots and flame shaped hemorrhages. Only rarely will there be retinal or macular edema. In advanced cases, there will be a macular star (ring of exudates from the disc to the macula) and disc edema. Arteriolosclerosis (arteriolar narrowing, arterio-venous crossing changes with venous constriction and banking, arteriolar color changes, vessel sclerosis) is often found concurrently.

Pathophysiology The findings in hypertensive retinopathy all stem from hypertension-induced changes to the retinal microvasculature. Hypertension leads to a laying down of cholesterol into the tunica intima of medium and large arteries. This leads to an overall reduction in the lumen size of these vessels. In arteriolosclerosis, hypertension leads to focal closure of the retinal microvasculature. This gives rise to microinfarcts (cotton wool spots) and superficial hemorrhages. In extreme cases, disc edema develops. The mechanism behind this phenomenon is poorly understood, but it may be related to a hypertension-related increase in intracranial pressure, and hence is considered true papilledema.

Arteriolosclerotic changes in the retinal microvasculature persist even with the reduction of systemic blood pressure. However, hypertensive retinopathy changes resolve over time with the reduction of systemic blood pressure (BP). Cotton wool spots develop in 24 to 48 hours with the elevation of BP, and resolve in two to 10 weeks with the lowering of BP. A macular star develops within several weeks of the development of elevated BP and resolves within months to years after the BP is reduced. Papilledema develops within days to weeks of increased BP and resolves within weeks to months following BP lowering.

Management Management of hypertensive retinopathy involves appropriate treatment of the underlying hypertension. Medical co-management with the primary physician is of paramount importance. However, if a patient presents with papilledema from hypertension, then the patient has malignant hypertension and should be considered to be in medical crisis. This patient needs immediate consult with a primary care physician and, most likely, immediate transport to a hospital emergency room.

It must be reiterated, however, that there are many causes of papilledema. Other causes of papilledema, such as an intracranial mass lesion, must also be considered in the patient with hypertension. However, in a case where blood pressure is extremely elevated (e.g. 250/150mmHg) and there is disc edema with a macular star, malignant hypertension is the likely cause.

Clinical Pearls

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• In order for cotton wool spots to develop from hypertension, autoregulatory mechanisms must first be overcome. For this to happen, the patient must have at least 110mmHg diastolic readings.
• Patients who develop papilledema from hypertension have malignant hypertension and typically have BP in the range of 250/150mmHg
• Fluorescein angiography is not indicated in cases of hypertensive retinopathy as it yields no diagnostic information.
• Hypertensive retinopathy presents with a ‘dry’ retina (few hemorrhages, rare edema, rare exudate, and multiple cotton wool spots) whereas diabetic retinopathy, in comparison, presents with a ‘wet’ retina (multiple hemorrhage, multiple exudate, extensive edema, and few cotton wool spots).
  
  
  
  
  
  
  This is the full paper link in indonesian :
  http://www.ziddu.com/download/12753245/BABIretinopatihiperensi.doc.html

1.2 Diplopia

Diplopia

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Double vision (diplopia) is one of the most troublesome visual disorders a patient can experience. The ability to read, walk and perform common activities is suddenly disrupted.    The management of double vision may include prisms, orthoptics, therapy, eye muscle surgery and occlusion.  The goal is to establish clear binocular single vision. Double vision management may require any combination of these therapies. Since some patients may recover function over time, surgery may be not be considered initially. Prisms should be used when it aids the patient in eliminating double vision. Press-on prisms may be applied to the patient's lenses to reduce double vision.  Orthoptic therapy may be indicated in many cases. When diplopia causes significant discomfort, and is not responsive to other therapies, occlusion may be used. Unfortunately many clinicians are still prescribing black "pirate" patches. These are rarely required.  New methods of occlusion are now available.

Double Vision Unresponsive to Orthoptics, Prism and Surgery While the goal is always to reform comfortable, functional binocular vision, this is not always possible. Some patients experience severe functional problems due to constant or intermittement double vision.

Management of Double Vision

New Semi-translucent Patching
Sector and Spot Patching
Mirror Occlusion Eyewear

        Neuro-Optometric Rehabilitation  Association Diplopia Section 

Fresnel Prism and Lens Company The Fresnel Prism and Lens Co. was founded in 1987 by Eugene L. Lewan Following a long term career with 3M(TM) company, where for many years as Director of International Marketing for the Health Care Group, he orchestrated the development and direction of 3M's(TM) Medical, Surgical and Dental Markets. It was clear from the beginning that there was a need for additional products to aid in the diagnostic and therapeutic issues related to Eye Care. This was especially noted when working closely with Eye Care Specialists i.e. Pediatric and Neuro-Ophthalmologists, Orthoptists, Optometrists, and other Low Vision practices.
3M press-on(TM) Optics was an obvious widely used product and became the major line around which other products were to follow. Initially the Fresnel Prism Trial Sets were reestablished. With an eye to the world for related products, the Ryser Bangerter Occlusion Foils, were added. These new products, relatively unknown in the USA, filled a professional need and clearly began to identify Fresnel Prism and Lens Co. as a key supplier to this narrow market within the Eye Care field.

This is the full paper link :
http://www.ziddu.com/download/12753211/BABIDIPLOPIA.doc.html

1.1 Astigmatism

Astigmatism is a vision condition that causes blurred vision due either to the irregular shape of the cornea, the clear front cover of the eye, or sometimes the curvature of the lens inside the eye. An irregular shaped cornea or lens prevents light from focusing properly on the retina, the light sensitive surface at the back of the eye. As a result, vision becomes blurred at any distance.

Astigmatism is a very common vision condition. Most people have some degree of astigmatism. Slight amounts of astigmatism usually don't affect vision and don't require treatment. However, larger amounts cause distorted or blurred vision, eye discomfort and headaches.

Astigmatism frequently occurs with other vision conditions like nearsightedness (myopia) and farsightedness (hyperopia). Together these vision conditions are referred to as refractive errors because they affect how the eyes bend or "refract" light.

The specific cause of astigmatism is unknown. It can be hereditary and is usually present from birth. It can change as a child grows and may decrease or worsen over time.

A comprehensive optometric examination will include testing for astigmatism. Depending on the amount present, your optometrist can provide eyeglasses or contact lenses that correct the astigmatism by altering the way light enters your eyes.

Another option for treating astigmatism uses a corneal modification procedure called orthokeratology (ortho-k). It is a painless, non-invasive procedure that involves wearing a series of specially designed rigid contact lenses to gradually reshape the curvature of the cornea.

Laser surgery is also a possible treatment option for some types of astigmatism. It changes the shape of the cornea by removing a small amount of eye tissue. This is done using a highly focused laser beam on the surface of the eye.

This is the link for full doc file abaut astigmatism, but i only can give you in Bahasa Indonesia...

http://www.ziddu.com/download/12726773/babAstigmatisma.doc.html





NB: If you want another title with full doc file just leave a reply.

1. opthalmology

Ophthalmology is the branch of medicine which deals with the anatomy, physiology and diseases of the eye. The term ophthalmologist refers to a specialist in medical and surgical eye problems.Since ophthalmologists perform operations on eyes, they are considered to be both surgical and medical specialists.

The word ophthalmology comes from the Greek roots ophthalmos meaning eye and logos meaning word, thought, or discourse; ophthalmology literally means "the science of eyes". "Opthomology" is a common mis-hearing or mis-remembering of the term. As a discipline, it applies to animal eyes also, since the differences from human practice are surprisingly minor and are related mainly to differences in anatomy or prevalence, not differences in disease processes.

0. THIS IS ME

hi, first before starting this blog I would like to introduce myself. My name may not have I mentioned, you can call me Mr.Q,I am a medical student at a university.the reason why I ventured to make this blog the past few years because I got a lot of paper work from my supervisor.this task which in my opinion not very useful because all of that done in the present paper is in the books, so why should I have great difficulty mengerjakanya.after getting the job I often find references on the internet, but what I can only raw materials that would be made in a paper anymore, so I had to retype everything I can, and it works most I do not like.So I made this blog for my work that hard if it can help you get a job with the same title with me.

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